Complex tools To aid public health decision making Dave Jephson, EMPHO Adapted from slides produced by: Helen Cooke, SWPHO May 2008

Health Poverty Index Health Profiles APHO Inequalities Toolkits –Spearheads –Internal inequalities in all Local Authorities Prevalence models

For each model: Understand its philosophy Understand the main ways you can use it Understand its strengths and weaknesses Understand how it might help your organisation

Health Poverty Index Commissioned by DH in Work done by University of St Andrews, the South East Public Health Observatory (SEPHO), the University of Oxford, and Oxford Consultants for Social Inclusion (OCSI) 2003 data currently most recent 2001 has data for different ethnic groups 2005 data are being prepared Data are old, but things don’t change very fast Good on wider determinants Located at

HPI indicators Root causesRegional prospectsGVA Change in job supply Educational resourcing Local ConditionsSocial Capital Education quality Household conditionsIncome Wealth Human capital Intervening FactorsResourcing to support healthLocal government resourcing Preventative care resourcing Healthy areasRecreation facilities Effective preventative healthcare Behaviours and environmentsLifestyle Home environments Work & local environments Situation of HealthResourcing for health & social careHealth care resourcing Social care resourcing Appropriate CareEffective primary care Access to secondary care Access to social care Quality of social care Health statusPsychological morbidity Health capital Physical morbidity Premature mortality

Example: Chesterfield & England, 2003

Example: Chesterfield, 2001: Bangladeshi & All Ethnic Groups

Exercise Open Internet Explorer and go to Click “The HPI tool” on the left hand side Select Nottingham as the main group Compare Nottingham in 2003 with: –England –Nottingham’s ONS supergroup What are the obvious patterns? Change to ranked data & compare Nottingham to England - What does it tell you? Go to the Indicators page. Explore meanings of: –Health Capital, Human Capital, Psychological morbidity Go to Tabled Data Could you use these data for further exploration?

HPI strengths Compact data presentation Comparative data Innovative indicators Helpful for partnership working HPI weaknesses Timeliness Absolute data Some data definitions are not intuitive No interpretation of PH significance of some indicators

Health Profiles Funded by Department of Health and produced annually (since 2006) by the Association of Public Heath Observatories Compact 4-page document (also available online) Document for all Local Authorities (District/Borough, Unitary Authority and County) Contains –Maps of SOA level deprivation –Trends in Life Expectancy, and early mortality from cancer and heart disease & stroke –Ethnicity breakdown Includes 31 indicators on wider determinants of health in a “Health Summary” Interpretation provided Also visualised through Instant Atlas – available at

Some of the indicators

Health Profiles - examples Mansfield Rushcliffe

Exercise Open Internet Explorer and go to Open the Health Profile for Mansfield. Using the Health Summary: –How many under 18 conceptions occurred? –What was the under 18 conception rate? What sort of rate is this? –How did this rate compare to the England rate? –What years does this data represent? Answer the same questions for infant deaths

Inequalities Intervention Tool for Spearhead areas The tool was developed by London Health Observatory and Yorkshire and Humber Public Health Observatory on behalf of the Association of Public Health Observatories for the Department of Health. This tool provides information on the following: ● The current life expectancy in Spearhead local authorities ● The current gap in life expectancy between the Spearhead local authorities and England ● A breakdown of the causes of the life expectancy gap by disease type and age It allows Spearhead areas to estimate the effect on their life expectancy gap if certain interventions are increased, specifically: ● Interventions to reduce infant mortality ● Smoking cessation ● Antihypertensive prescribing in people without diagnosed cardiovascular disease ● Statin prescribing in people without diagnosed cardiovascular disease These interventions are chosen because they can be influenced by PCT and LA commissioning

Spearhead Group areas (Local Authority Districts) In the East Midlands: Bolsover Corby Leicester Lincoln Nottingham

Exercise Copy the file “model_v35_for_web.xls” from the shared drive to your desktop Go to the Desktop and open the Excel file “model_v35_for_web.xls” Select “Enable Macros” Click on “Go to instructions” Click on “Go to model” Select Leicester UA from the drop down list Look at the current Local Authority information – what is the percentage life expectancy gap for males and females? Tick the box next to Smoking Cessation – see how the results change by altering the number of quitters to 5000 (remember to click “Calculate Results”) Click “View your Gap” Which disease groups had the biggest contribution to the gap for males and females?

APHO inequalities tool for all Local Authorities COMING SOON! Models the life expectancy gap between the most deprived quintile of any Local Authority and: –The local authority as a whole –The least deprived quintile in the local authority –The remainder of the local authority (ie the local authority without the most deprived quintile) –England as a whole –England's least deprived quintile You can then model interventions either across the most deprived quintile or the authority as a whole as with the Spearhead tool

Breakdown of life expectancy gap between the most deprived quintile of Northampton CD and the local authority average by cause of death

Life expectancy years gained if the most deprived quintile in Northampton CD had the same mortality rate as the local authority average for each cause of death.

Prevalence models Models from research of expected prevalence of the diseases measured in the Quality Outcome Framework (QOF) Currently, diabetes, CHD, COPD, hypertension Search on APHO website to find.

Prevalence models Comparisons of national prevalence data from the Health Survey for England (HSE) and recorded prevalence from the Quality & Outcomes Framework (QOF) suggest that there is considerable under-diagnosis (in terms of IT system recording) of risk factors and diseases.Health Survey for EnglandQuality & Outcomes Framework This is probably due to under-recording of cases already known to practices, and lack of information in a proportion of cases, where patients may have been diagnosed previously by other practices or hospital consultants.

JSNA interactive mapping tool Many JSNA indicators for all Local Authorities in England

What you should have learnt Major models to support decision making Their philosophy Their strengths and weaknesses How you might use them